APPLICANT'S ABSTRACT: The proposed study is designed to examine ways to increase routine and reliable screening of adolescents in managed care and primary health care clinics. The Adolescent Health Review screening instrument addresses alcohol abuse and other risk behaviors and was derived from a statewide school survey to facilitate the norming of items and scales for demographic subgroups. Response patterns of patients will be compared with those derived under anonymous school survey conditions to identify possible under reporting of sensitive behaviors in clinical settings. Three major methodological issues will be addressed: (1) response patterns for a computerized version and paper-and-pencil versions of the self-administered questionnaire will be compared; (2) response patterns will be compared among three groups of adolescents (those told results will be shared with their physician, results that may be shared upon discretion of the subjects, and results that will not be shared with the subject); and (3) whether and to what extent physicians and patients discuss sensitive topics discussed in the survey. A sample of 3,500 patients between the ages of 13 and 18 will be randomized to five groups. Learning more about the best methods to elicit honest self-disclosure from adolescents about risk behaviors and sensitive health related-issues, as well as identifying the best methods for facilitating physician-patient discussions of these topics, are essential to improving patient and physician compliance with recommendations for routine screening. Ultimately, improvements in screening methodologies will increase screening rates which will lead to earlier detection of alcohol abuse and other risk behaviors, reducing the harm associated with undetected and untreated disorders. The proliferation of current epidemiological survey data available throughout the country and the increasing reliance on computer technologies make this study especially timely and relevant for improving prevention and early intervention efforts in Minnesota and throughout the country. The screening content and scoring guidelines can be updated over time and modified to meet local needs elsewhere.